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BIBEKSHEEL
PARTY
Campaigner Form
First Name नाम
Last Name थर
Email इमेल
Choose a Province
Choose a Province प्रदेश
Choose District
Choose your district जिल्ला
Choose Local Level
Choose your Local level स्थानीय तह
Code कोड
Phone मोबाइल नं
How do you like to join us?
*
Required
Member
Volunteer
Campaigner
Financial Supporter
Citizenship ID/Passport नागरिकता/राहदानी
Upload Citizenship ID/Passport
Upload supported file (Max 15MB)
Do you have any disability? तपाईंलाई अपाङ्गता छ?
*
Yes
No
Ethnic Origin जात/जाति
Choose an option
Gender लिंग
Choose an option
Voter Id Number मतदाता परिचयपत्र नं
Citizenship Number नागरिकता नं
I hereby confirm that I am a citizen of Nepal and above 18. I agree to be a member of Bibeksheel Party and agree to abide by its statute. I give the permission to save, use my data for party internal purposes and contact me by various means. म १८ वर्ष पुगेको नेपाली नागरिक हुँ भनी स्वघोषणा गर्छु । मेरो स्वेच्छाले नै विवेकशील पार्टीको सदस्य भएको र यसका विधान तथा नियमहरूको पालना गर्न म प्रतिबद्धता व्यक्त गर्छु । मेरा व्यक्तिगत जानकारीहरूलाई संग्रह गरी पार्टीको आन्तरिक प्रयोजनको लागि उपयोग गर्नको तथा मलाई विभिन्न माध्यमबाट सम्पर्क गर्नको लागि म अनुमति दिन्छु ।
If you were a member of another party in the past, party's name and your position विगतमा अन्य दलको सदस्यता रहेको भए दलको नाम र पद
Facebook Profile Link फेसबुकको प्रोफाइल लिंक वा नाम
Register
What city you reside right now? तपाईं हाल बसोवास गरिरहेको सहर
Country you reside now तपाईं हाल बसोवास गरिरहेको देश
Select a country
Ward No. वडा नं
Your Signature हस्ताक्षर
Clear
Member ID
Date Of Birth जन्ममिति
Member Number
Citizenship ID/Passport Next Page नागरिकता/राहदानी पछाडी
Upload Citizenship ID/Passport (next page)
Upload supported file (Max 15MB)
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